Antiemetic superiority of lorazepam over oxazepam and methylprednisolone as premedicants for patients receiving cisplatin-containing chemotherapy

Abstract

Lorazepam, oxazepam, and methylprednisolone were compared for antiemetic efficacy in patients receiving cisplatin chemotherapy. Three consecutive courses of cisplatin-containing chemotherapy were administered at equal doses so that each patient acted as his own control. Of 100 patients randomized, 85 received at least two of the three agents and were evaluable for analysis. Lorazepam significantly reduced the number of patients with more than ten vomits compared to either oxazepam (P less than 0.05) or methylprednisolone (P less than 0.001). Lorazepam also significantly reduced the number of patients with the most severe degrees of vomiting compared to either oxazepam or methylprednisolone (both P less than 0.005). The duration of vomiting was reduced significantly after the first 48 hours postchemotherapy for those patients receiving lorazepam over those receiving methylprednisolone (P less than 0.05). Lorazepam significantly reduced the number of patients with severe nausea compared to both oxazepam and methylprednisolone (both P less than 0.05), but there were no significant differences in duration of nausea among the groups. The results of linear analogue self-assessment scores indicated a strong patient preference for lorazepam over both oxazepam and methylprednisolone. Drowsiness was significantly more common with both lorazepam and oxazepam compared to methylprednisolone (both P less than 0.001). Patients who received lorazepam or oxazepam also experienced significantly more severe drowsiness than those patients receiving methylprednisolone (both P less than 0.001). Lack of recall was significantly more common with lorazepam than with oxazepam and methylprednisolone (both P less than 0.001) and was more profound when lorazepam was compared with oxazepam (P less than 0.05) and with methylprednisolone (P less than 0.001). Methylprednisolone was administered with minimal side effects. The results of this randomized cross-over study indicate that, in the dosage/schedule used, lorazepam is a significantly superior premedicant than is either oxazepam or methylprednisolone in alleviating the distress of cytotoxic-induced emesis in patients receiving cisplatin-containing chemotherapy.